Arbitration of discrepant BI-RADS 0 recalls by a third reader at screening mammography lowers recall rate but not the cancer detection rate and sensitivity at blinded and non-blinded double reading

Klompenhouwer, Elisabeth G.; Weber, Roy J P; Voogd, Adri C.; Heeten, Gerard J. den; Strobbe, Luc J. A.; Broeders, Mireille J. M.; Tjan-Heijnen, V.C.; Duijm, Luciën E. M.

doi:10.1016/j.breast.2015.06.004

Cited by 17 publications

(12 citation statements)

References 24 publications

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“…In the Dutch screening setting, BI-RADS 0 represents a mammographic finding needing additional workup and it is generally considered to be a lesion with a relatively low malignancy risk, of ~7%. 18 In the Netherlands, nearly 70% of women with a BI-RADS 0 recall undergo non-invasive assessment only to confirm the benign nature of their abnormality detected at screening mammography, without the need of any additional biopsy procedures. 19 A possible explanation for the differences in recall BI-RADS would be that the percentage of BI-RADS 0 is higher in case of a discordant reading because two readers are more likely to agree on a more obvious (BI-RADS 4 or 5) abnormality.…”

Section: Discussionmentioning

confidence: 99%

Impact of the second reader on screening outcome at blinded double reading of digital screening mammograms

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Impact of the second reader on screening outcome at blinded double reading of digital screening mammograms

et al. 2018

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“…34,46 It has also been reported that blinded double reading, whereby the second reader was not aware of the first reader's suggestions, significantly increased the FP rates compared with a situation where double reading was not blinded. 47 The advantage of blind double reading, however, is the significant improvement in cancer detection sensitivity associated. 47 From these studies, it is clear that the policies which are implemented are important in affecting the probability for FP results.…”

Section: Screening Protocolmentioning

confidence: 99%

“…47 The advantage of blind double reading, however, is the significant improvement in cancer detection sensitivity associated. 47 From these studies, it is clear that the policies which are implemented are important in affecting the probability for FP results. Assessment of the scientific evidence and implementing policies which reflect the risks and benefits clarified in the literature will be crucial for limiting the FP rate.…”

Section: Screening Protocolmentioning

confidence: 99%

Is the false-positive rate in mammography in North America too high?

Le¹,

Mothersill²,

Seymour³

et al. 2016

BJR

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The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.

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“…This provides some evidence of the impact of blinding, but is not applicable to screening programmes where discordant decisions are arbitrated. Follow on studies assessed the impact of arbitration versus no arbitration of discrepant readings for both blinded and non-blinded reading [13,14]. To do this, they randomly assigned a third reader to decide retrospectively whether to recall a discrepant reading [13].…”

Section: Comparison With the Literaturementioning

confidence: 99%

Optimising breast cancer screening reading: blinding the second reader to the first reader’s decisions

et al. 2021

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Objectives In breast cancer screening, two readers separately examine each woman’s mammograms for signs of cancer. We examined whether preventing the two readers from seeing each other’s decisions (blinding) affects behaviour and outcomes. Methods This cohort study used data from the CO-OPS breast-screening trial (1,119,191 women from 43 screening centres in England) where all discrepant readings were arbitrated. Multilevel models were fitted using Markov chain Monte Carlo to measure whether reader 2 conformed to the decisions of reader 1 when they were not blinded, and the effect of blinding on overall rates of recall for further tests and cancer detection. Differences in positive predictive value (PPV) were assessed using Pearson’s chi-squared test. Results When reader 1 recalls, the probability of reader 2 also recalling was higher when not blinded than when blinded, suggesting readers may be influenced by the other’s decision. Overall, women were less likely to be recalled when reader 2 was blinded (OR 0.923; 95% credible interval 0.864, 0.986), with no clear pattern in cancer detection rate (OR 1.029; 95% credible interval 0.970, 1.089; Bayesian p value 0.832). PPV was 22.1% for blinded versus 20.6% for not blinded (p < 0.001). Conclusions Our results suggest that when not blinded, reader 2 is influenced by reader 1’s decisions to recall (alliterative bias) which would result in bypassing arbitration and negate some of the benefits of double-reading. We found a relationship between blinding the second reader and slightly higher PPV of breast cancer screening, although this analysis may be confounded by other centre characteristics. Key Points • In Europe, it is recommended that breast screening mammograms are analysed by two readers but there is little evidence on the effect of ‘blinding’ the readers so they cannot see each other’s decisions. • We found evidence that when the second reader is not blinded, they are more likely to agree with a recall decision from the first reader and less likely to make an independent judgement (alliterative error). This may reduce overall accuracy through bypassing arbitration. • This observational study suggests an association between blinding the second reader and higher positive predictive value of screening, but this may be confounded by centre characteristics.

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Arbitration of discrepant BI-RADS 0 recalls by a third reader at screening mammography lowers recall rate but not the cancer detection rate and sensitivity at blinded and non-blinded double reading

Cited by 17 publications

References 24 publications

Impact of the second reader on screening outcome at blinded double reading of digital screening mammograms

Impact of the second reader on screening outcome at blinded double reading of digital screening mammograms

Is the false-positive rate in mammography in North America too high?

Optimising breast cancer screening reading: blinding the second reader to the first reader’s decisions

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